Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
Eur J Prev Cardiol. 2023 Sep 6;30(12):1182-1192. doi: 10.1093/eurjpc/zwad099.
It is well established that obesity is associated with the risk of heart failure (HF). However, the data about relationship between visceral fat and the risk of HF are limited.
We aim to evaluate the association between visceral obesity assessed by visceral adiposity index (VAI) and incident HF and left ventricular (LV) structure and function in Atherosclerosis Risk in Communities (ARIC) study.
We included 12 161 participants (aged 54.1 ± 5.8 years) free of history of HF and coronary heart disease at baseline (1987-89) in ARIC study. We used multivariable Cox hazard regression models to assess the association between the VAI and incident HF. We further explored the effects of the VAI on LV geometry and function among 4817 participants with echocardiographic data using multivariable linear regression analysis and multinomial logistic regression.
During a median follow-up of 22.5 years, a total of 1904 (15.7%) participants developed HF. After adjustment for traditional HF risk factors, 1 unit increase in the baseline VAI was associated with an 8% higher risk of incident HF [hazard ratio (HR): 1.08, 95% confidence interval (CI): 1.06-1.11]. Results were similar when participants were categorized by VAI tertiles. Compared with participants in the lowest tertile of VAI, those in the second tertile and third tertile had a greater risk of incident HF [HR (95% CI): 1.19 (1.05-1.34) and 1.42 (1.26-1.61), respectively]. For the analyses of the HF subtypes, the higher VAI was only associated with the risk of HF with preserved ejection fraction, not with HF with reduced ejection fraction. In addition, the greater VAI was associated with worse LV diastolic function and abnormal LV geometry including concentric remodelling, concentric hypertrophy, and eccentric hypertrophy.
This study shows that higher VAI was independently associated with the increased risk of incident HF and abnormal LV geometry and LV diastolic dysfunction.
肥胖与心力衰竭（HF）风险相关已得到充分证实。然而，关于内脏脂肪与 HF 风险之间关系的数据有限。
我们旨在评估通过内脏脂肪指数（VAI）评估的内脏肥胖与 ARIC 研究中 HF 事件和左心室（LV）结构和功能之间的关系。
我们纳入了 ARIC 研究中 12161 名基线时（1987-89 年）无 HF 和冠心病病史且年龄为 54.1±5.8 岁的参与者。我们使用多变量 Cox 风险回归模型评估 VAI 与 HF 事件之间的关联。我们进一步使用多变量线性回归分析和多项逻辑回归分析在具有超声心动图数据的 4817 名参与者中探索了 VAI 对 LV 几何形状和功能的影响。
在中位随访 22.5 年期间，共有 1904 名（15.7%）参与者发生 HF。在调整传统 HF 风险因素后，基线 VAI 增加 1 个单位与 HF 事件风险增加 8%相关[风险比（HR）：1.08，95%置信区间（CI）：1.06-1.11]。当参与者按 VAI 三分位数分类时，结果相似。与 VAI 最低三分位的参与者相比，第二三分位和第三三分位的参与者发生 HF 的风险更高[HR（95%CI）：1.19（1.05-1.34）和 1.42（1.26-1.61）]。对于 HF 亚型的分析，较高的 VAI 仅与射血分数保留的 HF 风险相关，而与射血分数降低的 HF 无关。此外，VAI 越高与 LV 舒张功能障碍和异常 LV 几何形状（包括同心重构、同心肥厚和偏心肥厚）相关。
本研究表明，较高的 VAI 与 HF 事件风险增加以及异常 LV 几何形状和 LV 舒张功能障碍独立相关。
